Effect of cervical collars on intracranial pressure in patients with head neurotraumaLuis RafaelMoscote-Salazar1Neurosurgeon-Critical Care, RED LATINO. Latin American Trauma & Intensive Neuro-Care Organization, Bogota, ColombiaauthorDaniel A.GodoyUnidad de Cuidados Neurointensivos, Sanatorio Pasteur y Unidad de Terapia Intensiva, Hospital San Juan Bautista, Catamarca, ArgentinaauthorAmitAgrawalDepartment of Neurosurgery, Narayna Medical College Hospital, Chinthareddypalem, Nellore-524003, Andhra Pradesh, IndiaauthorAndres M.RubianoEl Bosque University, RED LATINO. Latin American Trauma & Intensive Neuro-Care Organization, Bogota, Colombiaauthortextarticle2018engTrauma patients are at high risk of cervical and associated injuries. The standard protocol includes immobilization of the cervical spine in a polytrauma as it will help to prevent spinal injuries in the prehospital settings. Hard cervical collar (or alternatives) is routinely used until the cervical spine clearance is obtained . In patients with traumatic brain injury avoiding any kind of maneuver may lead to increased intracranial pressure.Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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201812http://www.jept.ir/article_45959_7f8cfb5dfa08078d097be7201f804d69.pdfdx.doi.org/10.15171/jept.2017.03Factors predicting patient satisfaction in the emergency department: a single-center studySomayeYounesianDepartment of Emergency Medicine, Ayatollah Kashani Hospital, Tehran, IranauthorRezaShirvaniDepartment of Emergency Medicine, Nekoee-Hedayati Hospital, Qom University of Medical Sciences, Qom, IranauthorAliTabatabaeyDepartment of Emergency Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iranauthortextarticle2018engObjective: Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center. Method: Random shifts during a week were selected and all patients disposed from the ED were asked to fill out a revised and validated Persian version of the Press-Ganey questionnaire with the help of a research assistant. Results were analyzed using a linear regression model by SPSS software version 21. Results: Findings reaffirmed some of the factors previously described. These included longer door to treatment area times having a negative effect on satisfaction (P < 0.001), and providing vivid discharge information improving PS (P < 0.001). Other important factors were also found that had not previously been focused on, namely cleanliness of the area (P < 0.0001) and courtesy of the staff in charge of patient transfer (P = 0.03). We also found that men had a more satisfying ED experience (P = 0.002). Conclusion: Cultural expectations may have an important effect on PS. Thus, every institution should determine and alter the expectations most relevant to them.Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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201838http://www.jept.ir/article_46515_ff22a48d60758aee4fb449e3e7c2908b.pdfdx.doi.org/10.15171/jept.2017.16Evaluating the accuracy of emergency nurses in correct triage using emergency severity index triage in Sina hospital of Tabriz: a cross-sectional analysisFarzadRahmaniRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranauthorPegahSepehri MajdDepartment of Internal Medicine, Tabriz branch, Islamic Azad University, Tabriz, IranauthorHaniyehEbrahimi BakhtavarEmergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, IranauthorFarnazRahmaniStudent Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iranauthortextarticle2018eng Objective: Triage refers to the evaluation and categorization of patients for better management to deliver services. A good triage system should be able to accurately specify the patients who require urgent care. Thus, this study aimed to evaluate the accuracy of emergency nurses in correct triage using Emergency Severity Index (ESI) triage. Methods: In this descriptive cross-sectional study 750 patients, who referred to the emergency department (ED) of Sina teaching hospital, participated from 23 July to 22 August in 2015. Participants were selected using convenience sampling method. The patients’ triage level was determined by physicians and nurses separately and the results were compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. Data were analyzed using SPSS version 17. Results: Among 750 patients, 577 patients (76.9%) were classified in correct triage group, 90 patients (12%) in undertriage group and 83 patients (11.1%) in overtriage group. Kappa agreement coefficient between the ESI triage level of physicians and nurses was 0.659 (95% CI: 0.646-0.667). There was statistically significant difference between the triage level of physicians and nurses (P < 0.001). Conclusion: This study showed that there was moderate agreement between the triages of physicians and nurses. It seems that improving nurses’ skills and knowledge might increase the accuracy of emergency nurses in patients’ correct triage. Therefore, planning programs based on training correct triage for emergency nurses is strongly suggested.Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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2018913http://www.jept.ir/article_46516_78596829ae0ec85c2f9f1d03ec4ecf1a.pdfdx.doi.org/10.15171/jept.2017.19The effect of training on the management of nuclear disasters by emergency department nurses and physiciansAlirezaAlaEmergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, IranauthorFarzadRahmaniEmergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, IranauthorRezaAslzadEmergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, IranauthorZahraParsianEmergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iranauthortextarticle2018engObjective: On account of the widespread use of nuclear energy in different fields, nuclear accidents and disasters have been on a rise. Thus, it is crucial for medical staff especially emergency department personnel to be aware of the nature of these accidents. This study was designed to evaluate the effect of training on the knowledge of physicians and nurses regarding nuclear disasters. Methods: This pre-and post-intervention study was conducted on 97 emergency department personnel including physicians and nurses of educational hospitals in Tabriz University of Medical Sciences. Educational classes and training about nuclear disasters and managing these events were held. A standard questionnaire was used to evaluate the knowledge before and after training, and the effect of education on personnel’s knowledge. Results: Our participants included 41 males and 56 females. The mean age was 32.88 years. The mean score of participants before and after the class was 4.03 ± 1.54 and 7.93 ± 1.55 respectively; which showed a statistically significant difference (P < 0.001). Among medical staff, physicians had better knowledge compared with the other group. Conclusion: This study showed that the knowledge of medical staff about nuclear disasters is low and educational classes are necessary to increase their knowledge.Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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20181417http://www.jept.ir/article_46517_c1e2207d314b5e2ba061be1e4b1bfb2c.pdfdx.doi.org/10.15171/jept.2017.20The relationship between attention-deficit/ hyperactivity disorder and trauma in adolescentsAli RezaShafiee-KandjaniRoad Traffic Injury Research Center (RTIR), Tabriz University of Medical Sciences, Tabriz, IranauthorSeyed GholamrezaNoorazarResearch Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, IranauthorSaeedAslanabadiDepartment of Surgery, Tabriz University of Medical Sciences, Tabriz, IranauthorNasimRashediResearch Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, IranauthorMehrnazDadkhahResearch Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, IranauthorMohsenJafarzadeh-GharehziaaddinDepartment of Psychology, Islamic Azad University of Ahar, Tabriz, Iranauthortextarticle2018engObjective: Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent and impairing levels of inattention, impulsivity and hyperactivity. Evidence shows that adolescents with ADHD are more exposed to trauma. This study aimed to investigate the relationship between ADHD symptom severity and trauma severity. Methods: In this descriptive correlational study, the study population included traumatic adolescents aged 12-18 years referred to Shohada hospital in Tabriz, Iran in 2016. Among this population, 91 subjects were selected. In order to exclude subjects with other psychiatric disorders, a psychiatrist performed clinical interviews with them. In this regard, the short form of Conner’s Comprehensive Behavior Rating Scales Revised Edition (CBRS-R) and Pediatric Trauma Scale were used. For data analysis, Pearson correlation coefficient and independent t test were applied. Data were analyzed using SPSS software version 22. Results: There was a significant positive relationship between trauma severity and ADHD score, hyperactivity, and oppositional/Impulsivity (P < 0.01). Conversely, no statistical significance was observed between attention deficiency and trauma severity. The severity of trauma was higher among ADHD group than normal individuals. There were also correlations between socioeconomic status (SES) and oppositional/impulsive patients. In this regard, higher scores of oppositional/impulsivity were observed among patients with lower SES. Conclusion: Traumas have significant effects on economic and humanistic aspects of life in modern era. Our findings showed that there was a statistically significant relationship between hyperactivity-inattention and trauma intensity in adolescents. Therefore, to prevent traumatic events, ADHD screening at schools is suggested. By the same token, informing parents through mass media can help reduce the consequences of inattention/ hyperactivity disorder in the society.Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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20181823http://www.jept.ir/article_48849_c235f5ccafdcd723e3fe062d71e778b3.pdfdx.doi.org/10.15171/jept.2017.23The use of ultrasonography for the confirmation of pulled elbow treatmentFarhadHeydariEmergency Medicine Research Center, Alzahra Hospital, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, IranauthorShivaSamsam ShariatEmergency Medicine Department, Alzahra Hospital, Medical University of Isfahan, Isfahan, IranauthorSaeedMajidinejadEmergency Medicine Research Center, Alzahra Hospital, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, IranauthorBabakMasoumiEmergency Medicine Research Center, Alzahra Hospital, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iranauthortextarticle2018engObjective: The aim of this study was to use ultrasonography for the diagnosis and confirmation of Pulled Elbow treatment.Methods: This descriptive cross-sectional study initiated in 2014 and continued until 2015. We used simple sampling method and recruited 60 samples among patients aged 4 months to 6 years. The apparatus used in this study was an ultrasonogram with transducer 12 MHz probe. Ultrasound evaluation of both hands was undertaken and after reduction, the physical examination was performed to confirm the diagnosis made by ultrasonography. Then, the results were recorded by a physician in a checklist and entered into SPSS software (version 20) for further analysis.Results: In this study, 60 children with pulled elbow injuries were studied. Of these, 27 patients (45%) were girls (female) and 33 (55%) were boys (male). This indicates the higher incidence of injury among males than females. The highest incidence of pulled elbow injury was observed in children aged 3 (15%). The accuracy of ultrasonography method for the confirmation of treatment was reported to be 92%.Conclusion: This study aimed to confirm the considered therapeutic method based on the result of ultrasonography performed after the treatment. Accordingly, the sensitivity and specificity of ultrasonography in confirming the considered therapeutic method for the treatment of pulled elbow was obtained higher than 90%.Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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20182428http://www.jept.ir/article_50284_92de5b5ec9c2e3d6552a1c5a9c250e93.pdfdx.doi.org/10.15171/jept.2017.24The effect of physiologic dose of intravenous hydrocortisone in patients with refractory septic shock: a randomized control trialMortezaTalebi DolueeDepartment of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranauthorMaryamSalehiResearch Centre for Patient Safety, Mashhad University of Medical Sciences, Mashhad, IranauthorAzadehMahmoudi GharaeeTaleghani Hospital, Mashhad University of Medical Sciences, Mashhad, IranauthorMajidJalalyazdiDepartment of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranauthorHamidrezaReihaniDepartment of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iranauthortextarticle2018engObjective: Septic shock is a response to infection and tissue hypoperfusion which does not respond to fluid therapy and eventually leads to organ dysfunction. Aggressive treatment of a broad-spectrum antimicrobial and supportive measures are the cornerstones of successful treatment. In addition to the main treatment, there are adjunctive therapies. Steroids are one of the treatments which have been studied in the management of refractory septic shock. Despite numerous studies on the role of steroids in the mortality of severe sepsis and septic shock, still lots of controversies exist. These conflicts are often about the steroid dose and duration of administration.Methods: This was a prospective, randomized-controlled, two-group assignment study. Patients referred to Imam Reza (AS) hospital in Mashhad who had refractory septic shock criteria were randomly divided into two groups: 80 patients were included in each group. After obtaining the baseline cortisol level and cosyntropin test, one group was treated with intravenous hydrocortisone, and the other group was treated with placebo. The response to hydrocortisone, the return of shock duration, and mortality at 28 days were investigated. The data were analyzed using SPSS version 16. For the normally distributed variables, a t test was used for comparisons. Concerning qualitative variables, the chi-square test or Fisher exact test were applied accordingly.Results: The return of shock duration and mortality in intervention group patients was more than control group, but it was not statistically significant.Conclusion: Despite numerous studies in this field, there are various outcomes (mortality rate, rate of return of shock, time of return of shock). These differences can be attributed to high degree of heterogeneity. Perhaps considering the underlying disease and more differentiation could change the return of shock and mortality rate.Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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20182933http://www.jept.ir/article_50285_a830d1a10a8b2fb88b40ff3cbfa4dbe8.pdfdx.doi.org/10.15171/jept.2017.25Red blood cell distribution width: a determinant of hospital mortality in pancreatitisPaymanMoharamzadehGastrointestinal and Liver Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranauthorKavousShahsavari NiaRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranauthorMohammadhosseinSomiGastrointestinal and Liver Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranauthorMahboubPouraghaeiGastrointestinal and Liver Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranauthorAkbarFadaeihaghiStudent’s Research Committee, Tabriz University of Medical Sciences, Tabriz, IranauthorFarzadRahmaniRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iranauthortextarticle2018engObjective: In recent years, there has been a great attention concerning red blood cell distribution width (RDW) in clinical decisions as well as determining the severity of diseases. This study was conducted to evaluate the primary level of RDW to predict hospital mortality in pancreatitis.
Methods: This was a descriptive analytical study performed on 100 patients with acute pancreatitis in the emergency department of Imam Reza hospital of Tabriz University of Medical Sciences. In this study, the primary level of RDW in patients with acute pancreatitis presenting to the emergency ward was collected and after patients’ admission we followed them. Also, the admission outcome (mortality or discharge) of patients was registered, and finally we evaluated the predictive value of RDW in determining the patient’s outcome in hospital.
Results: In our study, 47 patients were male, and 53 patients were female. Mean RDW in patients was 13.82 ± 1.69. Five patients died during the study. Mean RDW in dead patients and other patients was 16.44 ± 4.22 and 13.68 ± 1.37, respectively (P < 0.001). The cut-off point of 14.55 for RDW with 80% sensitivity and 85% specificity was determined for predicting mortality in patients.
Conclusion: Based on our study results, the initial RDW level is an independent factor for predicting in-hospital mortality in pancreatitis but not for determining the need for surgery or admission to the intensive care unit (ICU).Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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20183438http://www.jept.ir/article_53304_ca6d7b67079801be4bd99b46c798c413.pdfdx.doi.org/10.15171/jept.2017.26Intravenous acetaminophen versus morphine sulfate in pain management of acute renal colic: a randomized clinical trialSeyyed HoseinMontazerDepartment of Emergency Medicine, Mazandaran University of Medical Science, Sari, IranauthorBehzadFeizzadehDepartment of Urology, Mazandaran University of Medical Science, Sari, IranauthorFarzadBozorgiDepartment of Emergency Medicine, Mazandaran University of Medical Science, Sari, IranauthorSeyed MohammadHosseininejadDepartment of Emergency Medicine, Mazandaran University of Medical Science, Sari, IranauthorAyyoubBarzegarnezhadDepartment of Urology, Mazandaran University of Medical Science, Sari, IranauthorIrajGolikatirDepartment of Emergency Medicine, Mazandaran University of Medical Science, Sari, IranauthorFatemehJahanianDepartment of Emergency Medicine, Mazandaran University of Medical Science, Sari, IranauthorHasanMotamedDepartment of Emergency Medicine, Mazandaran University of Medical Science, Sari, IranauthorHamedAminiahidashtiDepartment of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iranauthortextarticle2018engObjective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard.
Methods: This double blind clinical trial was conducted on >18 years old renal colic patients in need of pain management in emergency department. Pain severity was recorded as 15, 30, and 60 minutes before injection, and 120 minutes after injection. In addition, side effects were compared between IV acetaminophen and morphine sulfate groups using SPSS version 16.
Results: A total of 355 patients were randomly allocated to one of the treatment groups. There were no significant differences between the two groups regarding baseline characteristic of participants. There was no significant difference in the pain intensity of the groups; 15 (P = 0.13) and 30 (P = 0.15) minutes after treatment. Although, the difference in pain severity was statistically significant between the two groups; 60 (P = 0.02) and 120 (P = 0.003) minutes after the infusion. This was not clinically important. The prevalence of side effects in morphine group was higher than the acetaminophen group (RR: 2.14, 95% CI: 1.53-2.98, P< 0.0001).
Conclusion: Based on the findings, IV morphine sulfate and acetaminophen had equal effectiveness regarding acute renal colic pain management, but considering the significantly higher frequency of side effects, IV acetaminophen seems to be a more reasonable choice in this regard.Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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20183943http://www.jept.ir/article_53321_99eb115daf6554af4fb5e91ab0acb469.pdfdx.doi.org/10.15171/jept.2017.33Epidemiological study of pregnant women admitted to the emergency departmentSeyedhosseinOjaghihaghighiEmergency Medicine Research Team,Tabriz University of Medical Sciences, Tabriz, IranauthorSamadShams VahdatiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranauthorSiminTaghaviDepartment of Gynecology, Tabriz University of Medical Sciences, Tabriz, IranauthorAydinRahimzade JahandariEmergency Medicine Research Team,Tabriz University of Medical Sciences, Tabriz, IranauthorPegahSepehri MajdEmergency Medicine Research Team,Tabriz University of Medical Sciences, Tabriz, IranauthorMohammadMirza-Aghazadeh-AttariMedical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iranauthortextarticle2018engObjective: Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child. Methods: In this retrospective study, the data including demographic information, chief complaint, the initial diagnosis, referral decision, final diagnosis, hospitalization outcome and pregnancy outcomes were studied on 239 pregnant women admitted to the emergency departments of the general hospitals of East Azerbaijan province. Results: The average age of patients was 27.54 years. The time period from the initial presentation to completely leave the emergency department was reported to be 3.66 hours on average. In this study, most patients (74.5%) did not have a history of abortion. Exploring the time of admission for all cases, most patients were admitted from 8 pm to 8 am (67.8%), and 32.2% were referred from 8 am to 8 pm. Concerning the time of pregnancy, 46.4% were at their second trimester of pregnancy. Most of the patients were admitted in cold seasons of the year. The most common chief compliant was abdominal pain with 32.2% frequency. In addition, the most frequent primary diagnoses were an acute abdomen and trauma at 25.5% and 14.2% respectively. Conclusion: Abdominal pain and acute abdomen have the most frequency as the chief compliant and initial diagnosis especially during the second trimester of pregnancy. In this regard, appropriate training and skillful staff are needed to deal with the complaints and complications of abdominal pain. More than half of pregnant women referred to the emergency departments were hospitalized or admitted to the intensive care unit (ICU). This signals the necessity of adequate facilities to provide proper care for this group.Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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20184447http://www.jept.ir/article_46518_7cdd4b260818a1468d86c30778255e17.pdfdx.doi.org/10.15171/jept.2017.21Open vertical sagittal fracture patella with fracture lateral condyle femur: approach to a rare injuryMohit KumarAroraDepartment of Orthopedics, UCMS and GTB Hospital, Delhi University, IndiaauthorElaMadaanDepartment of Orthopedics, UCMS and GTB Hospital, Delhi University, Indiaauthortextarticle2018engPatellar fracture is a relatively uncommon fracture especially the vertical sagittal type. In cases of high energy trauma injury, it is usually associated with fracture of ipsilateral distal femur or proximal tibia. However, the combination of vertical sagittal fracture patella and ipsilateral fracture lateral condyle is very rare. This necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Open reduction and internal fixation is the treatment of choice in managing these types of injuries. This should be followed by gradual mobilization of the affected knee joint. Weight bearing can be started once the fracture starts showing signs of union on X-rays. Literature search shows only one case report describing this pattern. The aim of this case report is to highlight the rarity of this injury, to understand the injury mechanism and surgical approach used for these injuries. The knowledge of this combination will help us manage these injuries so that good functional outcome is achievedJournal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444

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20184850http://www.jept.ir/article_45212_702a9033218770d0580b0017d26157c1.pdfdx.doi.org/10.15171/jept.2017.01Heart attack or rhabdomyolysis?MustafaBolatkaleDepartment of Emergency Medicine, Medipol University Hospital, İstanbul, TurkeyauthorMuhittinİşseverDepartment of Emergency Medicine, Medipol University Hospital, İstanbul, TurkeyauthorUlaşKaraoğluDepartment of Emergency Medicine, Medipol University Hospital, İstanbul, TurkeyauthorAhmet CagdasAcaraDepartment of Emergency Medicine, Gaziemir State Hospital, Izmir, TurkeyauthorMehtapBulutDepartment of Emergency Medicine, Gaziemir State Hospital, Izmir, Turkeyauthortextarticle2018eng Statins are commonly used drugs in the treatment of hyperlipidemia (HL), despite some undesirable side effects. These range from mild symptoms such as myopathy, muscle weakness and myalgia to severe muscle weakness associated with chronic myopathy and acute renal failure (ARF) as a result of rhabdomyolysis. The most serious and deadly side effect of statins is rhabdomyolysis. The case presented here is of a patient with rhabdomyolysis due to treatment with the antihyperlipidemic drug, atorvastatin.Journal of Emergency Practice and TraumaKerman University of Medical Sciences2383-45444